Agency Information Collection Activities: Proposed Request and Comment Request, 15412-15414 [2017-06025]
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15412
Federal Register / Vol. 82, No. 58 / Tuesday, March 28, 2017 / Notices
SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA–2017–0013]
Agency Information Collection
Activities: Proposed Request and
Comment Request
The Social Security Administration
(SSA) publishes a list of information
collection packages requiring clearance
by the Office of Management and
Budget (OMB) in compliance with
Public Law 104–13, the Paperwork
Reduction Act of 1995, effective October
1, 1995. This notice includes revisions
of OMB-approved information
collections.
SSA is soliciting comments on the
accuracy of the agency’s burden
estimate; the need for the information;
its practical utility; ways to enhance its
quality, utility, and clarity; and ways to
minimize burden on respondents,
including the use of automated
collection techniques or other forms of
information technology. Mail, email, or
fax your comments and
recommendations on the information
collection(s) to the OMB Desk Officer
and SSA Reports Clearance Officer at
the following addresses or fax numbers.
(OMB), Office of Management and
Budget, Attn: Desk Officer for SSA,
Fax: 202–395–6974, Email address:
OIRA_Submission@omb.eop.gov
(SSA), Social Security Administration,
OLCA, Attn: Reports Clearance
Director, 3100 West High Rise, 6401
Security Blvd., Baltimore, MD 21235,
Fax: 410–966–2830, Email address:
OR.Reports.Clearance@ssa.gov
Or you may submit your comments
online through www.regulations.gov,
referencing Docket ID Number [SSA–
2017–0013].
I. The information collections below
are pending at SSA. SSA will submit
them to OMB within 60 days from the
date of this notice. To be sure we
consider your comments, we must
receive them no later than May 30,
2017. Individuals can obtain copies of
the collection instruments by writing to
the above email address.
1. Request for Waiver of Overpayment
Recovery or Change in Repayment
Number of
respondents
Modality of completion
Notice—20 CFR 404.502–404.513,
404.515, 416.550–416.570, and
416.572—0960–0037. When Social
Security beneficiaries and Supplemental
Security Income (SSI) recipients receive
an overpayment, they must return the
extra money. These beneficiaries and
recipients can use Form SSA–632–BK to
take one of three actions: (1) Request an
exemption from repaying, as recovery of
the payment would cause financial
hardship; (2) inform SSA they want to
repay the overpayment at a monthly rate
over a period longer than 36 months; or
(3) request a different rate of recovery.
In the latter two cases, the respondents
must also provide financial information
to help the agency determine how much
the overpaid person can afford to repay
each month. Respondents are overpaid
beneficiaries or SSI recipients who are
requesting: (1) A waiver of recovery of
an overpayment, or (2) a lesser rate of
withholding.
Type of Request: Revision of an OMBapproved information collection.
Average
burden per
response
(minutes)
Frequency
of response
Estimated
total annual
burden
(hours)
400,000
100,000
44,000
500,000
1
1
1
1
120
45
120
5
800,000
75,000
88,000
41,667
Totals ........................................................................................................
sradovich on DSK3GMQ082PROD with NOTICES
Waiver of Overpayment (Completes Whole Paper Form) ..............................
Change in Repayment (Completes Partial Paper Form) ................................
Regional Application (New York Debt Management) ......................................
Internet Instructions .........................................................................................
1,044,000
........................
........................
1,004,667
2. RS/DI Quality Review Case
Analysis: Sampled Number Holder;
Auxiliaries/Survivors; Parent; and
Stewardship Annual Earnings Test—
0960–0189. Section 205(a) of the Social
Security Act (Act) authorizes the
Commissioner of SSA to conduct the
quality review process, which entails
collecting information related to the
accuracy of payments made under the
Old-Age, Survivors, and Disability
Insurance Program (OASDI). Sections
228(a)(3), 1614(a)(1)(B), and 1836(2) of
the Act require a determination of the
citizenship or alien status of the
beneficiary; this is only one item that
we might question as part of the Annual
Quality review. SSA uses Forms SSA–
2930, SSA–2931, and SSA–2932 to
establish a national payment accuracy
rate for all cases in payment status, and
to serve as a source of information
VerDate Sep<11>2014
17:14 Mar 27, 2017
Jkt 241001
regarding problem areas in the
Retirement Survivors Insurance (RSI)
and Disability Insurance (DI) programs.
We also use the information to measure
the accuracy rate for newly adjudicated
RSI or DI cases. SSA uses Form SSA–
4659 to evaluate the effectiveness of the
annual earnings test, and to use the
results in developing ongoing
improvements in the process. About
twenty-five percent of respondents will
have in-person reviews and receive one
of the following appointment letters: (1)
SSA–L8550–U3 (Appointment Letter—
Sample Individual); (2) SSA–L8551–U3
(Appointment Letter—Sample Family);
or (3) the SSA–L8552–U3 (Appointment
Letter—Rep Payee). Seventy-five
percent of respondents will receive a
notice for a telephone review using the
SSA–L8553–U3 (Beneficiary Telephone
Contact) or the SSA–L8554–U3 (Rep
PO 00000
Frm 00099
Fmt 4703
Sfmt 4703
Payee Telephone Contact). To help the
beneficiary prepare for the interview,
we include three forms with each
notice: (1) SSA–85 (Information Needed
to Review Your Social Security Claim)
lists the information the beneficiary will
need to gather for the interview; (2)
SSA–2935 (Authorization to the Social
Security Administration to Obtain
Personal Information) verifies the
beneficiary’s correct payment amount, if
necessary; and (3) SSA–8552 (Interview
Confirmation) confirms or reschedules
the interview if necessary. The
respondents are a statistically valid
sample of all OASDI beneficiaries in
current pay status or their representative
payees.
Type of Request: Revision of an OMBapproved information collection.
E:\FR\FM\28MRN1.SGM
28MRN1
15413
Federal Register / Vol. 82, No. 58 / Tuesday, March 28, 2017 / Notices
Number of
respondents
Modality of completion
Average
burden per
response
(minutes)
Frequency
of response
Estimated
total annual
burden
(hours)
SSA–2930 ........................................................................................................
SSA–2931 ........................................................................................................
SSA–4659 ........................................................................................................
SSA–L8550–U3 ...............................................................................................
SSA–L8551–U3 ...............................................................................................
SSA–L8552–U3 ...............................................................................................
SSA–L8553–U3 ...............................................................................................
SSA–L8554–U3 ...............................................................................................
SSA–8552 ........................................................................................................
SSA–85 ............................................................................................................
SSA–2935 ........................................................................................................
SSA–8510 (also saved under OMB No. 0960–0707) .....................................
1,500
850
325
385
95
35
4970
705
2350
3850
2350
800
1
1
1
1
1
1
1
1
1
1
1
1
30
30
10
5
5
5
5
5
5
5
5
5
750
425
54
32
8
3
414
59
196
321
196
67
Totals ........................................................................................................
17,700
........................
........................
2,525
3. Electronic Records Express—20
CFR 404.1512 and 416.912—0960–0753.
Electronic Records Express (ERE) is a
Web-based SSA program which allows
medical and educational providers to
electronically submit disability claimant
data to SSA. Both medical providers
and other third parties with connections
to disability applicants or recipients
(e.g., teachers and school administrators
for child disability applicants) use this
system once they complete the
registration process. SSA employees and
State agency employees request the
medical and educational records
collected through the ERE Web site. The
agency uses the information collected
through ERE to make a determination on
an Application for Benefits. We also use
the ERE Web site to order and receive
consultative examinations when we are
unable to collect enough medical
records to determine disability findings.
The respondents are medical providers
who evaluate or treat disability
claimants or recipients, and other third
parties with connections to disability
applicants or recipients (e.g., teachers
and school administrators for child
disability applicants), who voluntarily
choose to use ERE for submitting
information.
Type of Request: Revision of an OMBapproved information collection.
Modality of completion
Number of
respondents
Frequency
of response
Average
burden per
response
(minutes)
Estimated
total annual
burden
(hours)
ERE ..................................................................................................................
5,376,998
1
10
896,166
II. SSA submitted the information
collections below to OMB for clearance.
Your comments regarding these
information collections would be most
useful if OMB and SSA receive them 30
days from the date of this publication.
To be sure we consider your comments,
we must receive them no later than
April 27, 2017. Individuals can obtain
copies of the OMB clearance packages
by writing to OR.Reports.Clearance@
ssa.gov.
1. State Mental Institution Policy
Review Booklet—20 CFR 404.2035,
404.2065, 416.635, & 416.665—0960–
0110. SSA uses Form SSA–9584–BK: (1)
To determine if the policies and
practices of a state mental institution
acting as a representative payee for SSA
beneficiaries conform to SSA’s
regulations in the use of benefits; (2) to
confirm institutions are performing
other duties and responsibilities
required of representative payees; and
(3) as the basis for conducting onsite
reviews of the institutions and
preparing subsequent reports of
findings. The respondents are state
mental institutions serving as
representative payees for Social Security
beneficiaries and SSI recipients.
Type of Request: Revision of an OMBapproved information collection.
Number of
respondents
Frequency
of response
Average
burden per
response
(minutes)
Estimated
total annual
burden
(hours)
SSA–9584–BK .................................................................................................
sradovich on DSK3GMQ082PROD with NOTICES
Modality of completion
69
1
60
69
2. Statement of Death by Funeral
Director—20 CFR 404.715 and
404.720—0960–0142. When an SSAinsured worker dies, the funeral director
or funeral home responsible for the
worker’s burial or cremation completes
Form SSA–721 and sends it to SSA.
VerDate Sep<11>2014
17:14 Mar 27, 2017
Jkt 241001
SSA uses this information for three
purposes: (1) To establish proof of death
for the insured worker; (2) to determine
if the insured individual was receiving
any pre-death benefits SSA needs to
terminate; and (3) to ascertain which
surviving family member is eligible for
PO 00000
Frm 00100
Fmt 4703
Sfmt 4703
the lump-sum death payment or for
other death benefits. The respondents
are funeral directors who handled death
arrangements for the insured
individuals.
Type of Request: Revision of an OMBapproved information collection.
E:\FR\FM\28MRN1.SGM
28MRN1
15414
Federal Register / Vol. 82, No. 58 / Tuesday, March 28, 2017 / Notices
Modality of completion
Number of
respondents
Frequency
of response
Average
burden per
response
(minutes)
Estimated
total annual
burden
(hours)
SSA–721 ..........................................................................................................
703,638
1
4
46,909
credit the earnings to the correct
individual and SSN. We send the SSA–
4156 to the employer to: (1) Identify the
employees involved; (2) resolve the
discrepancy; and (3) credit the earnings
to the correct SSN. The respondents are
3. Employee Identification
Statement—20 CFR 404.702—0960–
0473. When two or more individuals
report earnings under the same Social
Security Number (SSN), SSA collects
information on Form SSA–4156 to
employers involved in erroneous wage
reporting for an employee.
Type of Request: Revision of an OMBapproved information collection.
Modality of completion
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Estimated
total
annual burden
(hours)
SSA–4156 ........................................................................................................
4,750
1
10
792
4. Employee Work Activity
Questionnaire—20 CFR 404.1574,
404.1592—0960–0483. Social Security
Disability Insurance (SSDI) beneficiaries
and SSI recipients qualify for payments
when a verified physical or mental
impairment prevents them from
working. If disability claimants attempt
to return to work after receiving
payments, but are unable to continue
working, they submit the SSA–3033,
Employee Work Activity Questionnaire,
so SSA can evaluate their work attempt.
SSA also uses this form to evaluate
unsuccessful subsidy work and
determine applicants’ continuing
eligibility for disability payments. The
respondents are employers of SSDI
beneficiaries and SSI recipients who
unsuccessfully attempted to return to
work.
Type of Request: Revision of an OMBapproved information collection.
Modality of completion
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Estimated
total
annual burden
(hours)
SSA–3033–BK .................................................................................................
15,000
1
15
3,750
5. Request for Medical Treatment in
an SSA Employee Health Facility:
Patient Self-Administered or Staff
Administered Care—0960–0772. SSA
operates onsite Employee Health Clinics
(EHC) in eight different States. These
clinics provide health care for all SSA
employees including treatments of
personal medical conditions when
authorized through a physician. Form
SSA–5072 is the employee’s personal
physician’s order form. The information
we collect on Form SSA–5072 gives the
nurses the guidance they need by law to
perform certain medical procedures and
to administer prescription medications
such as allergy immunotherapy. In
addition, the form allows the medical
Number of
respondents
Modality of completion
SSA–5072 ............................................................................
Annually ...............................................................................
SSA–5072 ............................................................................
Bi-Annually ...........................................................................
Average
burden per
response
(minutes)
Number of
responses
1
25
5
2
75
2
150
5
13
100
........................
........................
........................
15
Dated: March 22, 2017.
Naomi R. Sipple,
Reports Clearance Officer, Social Security
Administration.
[FR Doc. 2017–06025 Filed 3–27–17; 8:45 am]
BILLING CODE 4191–02–P
VerDate Sep<11>2014
17:14 Mar 27, 2017
Jkt 241001
PO 00000
Frm 00101
Estimated
total
annual burden
(hours)
25
Totals ............................................................................
sradovich on DSK3GMQ082PROD with NOTICES
Frequency of
response
officer to determine whether they can
administer treatment safely and
appropriately in the SSA EHCs.
Respondents are physicians of SSA
employees who need to have medical
treatment in an SSA EHC.
Type of Request: Revision of an OMBapproved information collection.
Fmt 4703
Sfmt 9990
E:\FR\FM\28MRN1.SGM
28MRN1
]]>Agencies
[Federal Register Volume 82, Number 58 (Tuesday, March 28, 2017)]
[Notices]
[Pages 15412-15414]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-06025]
[[Page 15412]]
=======================================================================
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA-2017-0013]
Agency Information Collection Activities: Proposed Request and
Comment Request
The Social Security Administration (SSA) publishes a list of
information collection packages requiring clearance by the Office of
Management and Budget (OMB) in compliance with Public Law 104-13, the
Paperwork Reduction Act of 1995, effective October 1, 1995. This notice
includes revisions of OMB-approved information collections.
SSA is soliciting comments on the accuracy of the agency's burden
estimate; the need for the information; its practical utility; ways to
enhance its quality, utility, and clarity; and ways to minimize burden
on respondents, including the use of automated collection techniques or
other forms of information technology. Mail, email, or fax your
comments and recommendations on the information collection(s) to the
OMB Desk Officer and SSA Reports Clearance Officer at the following
addresses or fax numbers.
(OMB), Office of Management and Budget, Attn: Desk Officer for SSA,
Fax: 202-395-6974, Email address: OIRA_Submission@omb.eop.gov
(SSA), Social Security Administration, OLCA, Attn: Reports Clearance
Director, 3100 West High Rise, 6401 Security Blvd., Baltimore, MD
21235, Fax: 410-966-2830, Email address: OR.Reports.Clearance@ssa.gov
Or you may submit your comments online through www.regulations.gov,
referencing Docket ID Number [SSA-2017-0013].
I. The information collections below are pending at SSA. SSA will
submit them to OMB within 60 days from the date of this notice. To be
sure we consider your comments, we must receive them no later than May
30, 2017. Individuals can obtain copies of the collection instruments
by writing to the above email address.
1. Request for Waiver of Overpayment Recovery or Change in
Repayment Notice--20 CFR 404.502-404.513, 404.515, 416.550-416.570, and
416.572--0960-0037. When Social Security beneficiaries and Supplemental
Security Income (SSI) recipients receive an overpayment, they must
return the extra money. These beneficiaries and recipients can use Form
SSA-632-BK to take one of three actions: (1) Request an exemption from
repaying, as recovery of the payment would cause financial hardship;
(2) inform SSA they want to repay the overpayment at a monthly rate
over a period longer than 36 months; or (3) request a different rate of
recovery. In the latter two cases, the respondents must also provide
financial information to help the agency determine how much the
overpaid person can afford to repay each month. Respondents are
overpaid beneficiaries or SSI recipients who are requesting: (1) A
waiver of recovery of an overpayment, or (2) a lesser rate of
withholding.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency of burden per total annual
Modality of completion respondents response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
Waiver of Overpayment (Completes Whole Paper 400,000 1 120 800,000
Form)..........................................
Change in Repayment (Completes Partial Paper 100,000 1 45 75,000
Form)..........................................
Regional Application (New York Debt Management). 44,000 1 120 88,000
Internet Instructions........................... 500,000 1 5 41,667
---------------------------------------------------------------
Totals...................................... 1,044,000 .............. .............. 1,004,667
----------------------------------------------------------------------------------------------------------------
2. RS/DI Quality Review Case Analysis: Sampled Number Holder;
Auxiliaries/Survivors; Parent; and Stewardship Annual Earnings Test--
0960-0189. Section 205(a) of the Social Security Act (Act) authorizes
the Commissioner of SSA to conduct the quality review process, which
entails collecting information related to the accuracy of payments made
under the Old-Age, Survivors, and Disability Insurance Program (OASDI).
Sections 228(a)(3), 1614(a)(1)(B), and 1836(2) of the Act require a
determination of the citizenship or alien status of the beneficiary;
this is only one item that we might question as part of the Annual
Quality review. SSA uses Forms SSA-2930, SSA-2931, and SSA-2932 to
establish a national payment accuracy rate for all cases in payment
status, and to serve as a source of information regarding problem areas
in the Retirement Survivors Insurance (RSI) and Disability Insurance
(DI) programs. We also use the information to measure the accuracy rate
for newly adjudicated RSI or DI cases. SSA uses Form SSA-4659 to
evaluate the effectiveness of the annual earnings test, and to use the
results in developing ongoing improvements in the process. About
twenty-five percent of respondents will have in-person reviews and
receive one of the following appointment letters: (1) SSA-L8550-U3
(Appointment Letter--Sample Individual); (2) SSA-L8551-U3 (Appointment
Letter--Sample Family); or (3) the SSA-L8552-U3 (Appointment Letter--
Rep Payee). Seventy-five percent of respondents will receive a notice
for a telephone review using the SSA-L8553-U3 (Beneficiary Telephone
Contact) or the SSA-L8554-U3 (Rep Payee Telephone Contact). To help the
beneficiary prepare for the interview, we include three forms with each
notice: (1) SSA-85 (Information Needed to Review Your Social Security
Claim) lists the information the beneficiary will need to gather for
the interview; (2) SSA-2935 (Authorization to the Social Security
Administration to Obtain Personal Information) verifies the
beneficiary's correct payment amount, if necessary; and (3) SSA-8552
(Interview Confirmation) confirms or reschedules the interview if
necessary. The respondents are a statistically valid sample of all
OASDI beneficiaries in current pay status or their representative
payees.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 15413]]
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency of burden per total annual
Modality of completion respondents response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-2930........................................ 1,500 1 30 750
SSA-2931........................................ 850 1 30 425
SSA-4659........................................ 325 1 10 54
SSA-L8550-U3.................................... 385 1 5 32
SSA-L8551-U3.................................... 95 1 5 8
SSA-L8552-U3.................................... 35 1 5 3
SSA-L8553-U3.................................... 4970 1 5 414
SSA-L8554-U3.................................... 705 1 5 59
SSA-8552........................................ 2350 1 5 196
SSA-85.......................................... 3850 1 5 321
SSA-2935........................................ 2350 1 5 196
SSA-8510 (also saved under OMB No. 0960-0707)... 800 1 5 67
---------------------------------------------------------------
Totals...................................... 17,700 .............. .............. 2,525
----------------------------------------------------------------------------------------------------------------
3. Electronic Records Express--20 CFR 404.1512 and 416.912--0960-
0753. Electronic Records Express (ERE) is a Web-based SSA program which
allows medical and educational providers to electronically submit
disability claimant data to SSA. Both medical providers and other third
parties with connections to disability applicants or recipients (e.g.,
teachers and school administrators for child disability applicants) use
this system once they complete the registration process. SSA employees
and State agency employees request the medical and educational records
collected through the ERE Web site. The agency uses the information
collected through ERE to make a determination on an Application for
Benefits. We also use the ERE Web site to order and receive
consultative examinations when we are unable to collect enough medical
records to determine disability findings. The respondents are medical
providers who evaluate or treat disability claimants or recipients, and
other third parties with connections to disability applicants or
recipients (e.g., teachers and school administrators for child
disability applicants), who voluntarily choose to use ERE for
submitting information.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
ERE......................................... 5,376,998 1 10 896,166
----------------------------------------------------------------------------------------------------------------
II. SSA submitted the information collections below to OMB for
clearance. Your comments regarding these information collections would
be most useful if OMB and SSA receive them 30 days from the date of
this publication. To be sure we consider your comments, we must receive
them no later than April 27, 2017. Individuals can obtain copies of the
OMB clearance packages by writing to OR.Reports.Clearance@ssa.gov.
1. State Mental Institution Policy Review Booklet--20 CFR 404.2035,
404.2065, 416.635, & 416.665--0960-0110. SSA uses Form SSA-9584-BK: (1)
To determine if the policies and practices of a state mental
institution acting as a representative payee for SSA beneficiaries
conform to SSA's regulations in the use of benefits; (2) to confirm
institutions are performing other duties and responsibilities required
of representative payees; and (3) as the basis for conducting onsite
reviews of the institutions and preparing subsequent reports of
findings. The respondents are state mental institutions serving as
representative payees for Social Security beneficiaries and SSI
recipients.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-9584-BK................................. 69 1 60 69
----------------------------------------------------------------------------------------------------------------
2. Statement of Death by Funeral Director--20 CFR 404.715 and
404.720--0960-0142. When an SSA-insured worker dies, the funeral
director or funeral home responsible for the worker's burial or
cremation completes Form SSA-721 and sends it to SSA. SSA uses this
information for three purposes: (1) To establish proof of death for the
insured worker; (2) to determine if the insured individual was
receiving any pre-death benefits SSA needs to terminate; and (3) to
ascertain which surviving family member is eligible for the lump-sum
death payment or for other death benefits. The respondents are funeral
directors who handled death arrangements for the insured individuals.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 15414]]
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-721..................................... 703,638 1 4 46,909
----------------------------------------------------------------------------------------------------------------
3. Employee Identification Statement--20 CFR 404.702--0960-0473.
When two or more individuals report earnings under the same Social
Security Number (SSN), SSA collects information on Form SSA-4156 to
credit the earnings to the correct individual and SSN. We send the SSA-
4156 to the employer to: (1) Identify the employees involved; (2)
resolve the discrepancy; and (3) credit the earnings to the correct
SSN. The respondents are employers involved in erroneous wage reporting
for an employee.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4156.................................... 4,750 1 10 792
----------------------------------------------------------------------------------------------------------------
4. Employee Work Activity Questionnaire--20 CFR 404.1574,
404.1592--0960-0483. Social Security Disability Insurance (SSDI)
beneficiaries and SSI recipients qualify for payments when a verified
physical or mental impairment prevents them from working. If disability
claimants attempt to return to work after receiving payments, but are
unable to continue working, they submit the SSA-3033, Employee Work
Activity Questionnaire, so SSA can evaluate their work attempt. SSA
also uses this form to evaluate unsuccessful subsidy work and determine
applicants' continuing eligibility for disability payments. The
respondents are employers of SSDI beneficiaries and SSI recipients who
unsuccessfully attempted to return to work.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3033-BK................................. 15,000 1 15 3,750
----------------------------------------------------------------------------------------------------------------
5. Request for Medical Treatment in an SSA Employee Health
Facility: Patient Self-Administered or Staff Administered Care--0960-
0772. SSA operates onsite Employee Health Clinics (EHC) in eight
different States. These clinics provide health care for all SSA
employees including treatments of personal medical conditions when
authorized through a physician. Form SSA-5072 is the employee's
personal physician's order form. The information we collect on Form
SSA-5072 gives the nurses the guidance they need by law to perform
certain medical procedures and to administer prescription medications
such as allergy immunotherapy. In addition, the form allows the medical
officer to determine whether they can administer treatment safely and
appropriately in the SSA EHCs. Respondents are physicians of SSA
employees who need to have medical treatment in an SSA EHC.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of Number of burden per Estimated
Modality of completion respondents response responses response total annual
(minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-5072........................ 25 1 25 5 2
Annually........................
SSA-5072........................ 75 2 150 5 13
Bi-Annually.....................
-------------------------------------------------------------------------------
Totals...................... 100 .............. .............. .............. 15
----------------------------------------------------------------------------------------------------------------
Dated: March 22, 2017.
Naomi R. Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2017-06025 Filed 3-27-17; 8:45 am]
BILLING CODE 4191-02-P
